Miller William R, Wilbourne Paula L
Center on Alcoholism, Substance Abuse and Addictions and Department of Psychology, The University of New Mexico, Albuquerque 87131-1161, USA.
Addiction. 2002 Mar;97(3):265-77. doi: 10.1046/j.1360-0443.2002.00019.x.
A 3-year update with 59 new controlled trials is provided for the ongoing Mesa Grande project reviewing clinical trials of treatments for alcohol use disorders. The project summarizes the current evidence for various treatment approaches, weighting findings differentially according to the methodological strength of each study.
The review includes 361 controlled studies that (1) evaluated at least one treatment for alcohol use disorders, (2) compared it with an alternative condition (such as a control group, a placebo, a brief intervention or an alternative treatment), (3) used a procedure designed to create equivalent groups before treatment and (4) reported at least one outcome measure of drinking or alcohol-related consequences. Studies were rated by two reviewers on 12 methodological criteria, and outcome logic was analyzed for the specific treatment modalities tested.
Methodological quality of studies was significantly but modestly correlated with the reporting of a specific effect of treatment. Among psychosocial treatments, strongest evidence of efficacy was found for brief interventions, social skills training, the community reinforcement approach, behavior contracting, behavioral marital therapy and case management. For the first time, two pharmacotherapies also appeared among the most strongly supported approaches: opiate antagonists (naltrexone, nalmefene) and acamprosate. Least supported were methods designed to educate, confront, shock or foster insight regarding the nature and causes of alcoholism.
Treatment methods differ substantially in apparent efficacy. It would be sensible to consider these differences in designing and funding treatment programs.
为正在进行的格兰德台地项目提供一份包含59项新对照试验的3年更新内容，该项目旨在回顾酒精使用障碍治疗的临床试验。该项目总结了各种治疗方法的现有证据，并根据每项研究的方法学优势对研究结果进行了不同权重的考量。
该综述纳入了361项对照研究，这些研究（1）评估了至少一种酒精使用障碍的治疗方法，（2）将其与另一种对照情况（如对照组、安慰剂、简短干预或替代治疗）进行比较，（3）采用了一种旨在在治疗前创建等效组的程序，（4）报告了至少一项饮酒或与酒精相关后果的结局指标。两名评审员根据12项方法学标准对研究进行评分，并对所测试的特定治疗方式的结局逻辑进行了分析。
研究的方法学质量与治疗特定效果的报告之间存在显著但适度的相关性。在心理社会治疗中，简短干预、社交技能训练、社区强化方法、行为契约、行为婚姻治疗和病例管理的疗效证据最为充分。两种药物疗法也首次出现在最受支持的方法之中：阿片类拮抗剂（纳曲酮、纳美芬）和阿坎酸。支持力度最小的是旨在就酒精中毒的性质和原因进行教育、对抗、冲击或促进洞察力的方法。
治疗方法的明显疗效差异很大。在设计和资助治疗项目时考虑这些差异是明智的。
